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A BILL TO BE ENTITLED
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AN ACT
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relating to rate-setting and data collection processes under the |
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program of all-inclusive care for the elderly. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Sections 32.0532, 32.0533, and 32.0534 to read |
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as follows: |
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Sec. 32.0532. PACE PROGRAM REIMBURSEMENT METHODOLOGY. (a) |
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In this section and Sections 32.0533 and 32.0534: |
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(1) "Commission" means the Health and Human Services |
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Commission. |
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(2) "PACE program" means the program of all-inclusive |
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care for the elderly (PACE) established under Section 32.053. |
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(b) In setting the reimbursement rates under the PACE |
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program, the executive commissioner of the commission shall ensure |
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that: |
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(1) reimbursement rates for providers under the |
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program are adequate to sustain the program; |
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(2) reimbursements paid under the program do not, in |
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the aggregate, exceed the reasonable and necessary costs to operate |
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the program; and |
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(3) the program is cost-neutral when compared to the |
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cost to serve a comparable population in the STAR + PLUS Medicaid |
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managed care program. |
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(c) For purposes of Subsections (b)(1) and (2), the |
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commission shall consider requiring providers under the PACE |
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program to report historical cost and utilization data. If the |
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commission requires providers to report historical cost and |
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utilization data under this section: |
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(1) the commission may establish a cost-reporting |
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structure that accommodates data collection from providers by |
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modifying as appropriate an existing cost-reporting structure used |
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for other programs administered by the commission; and |
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(2) the commission shall determine which costs the |
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commission considers reasonable and necessary under the program. |
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(d) For purposes of Subsection (b)(3), the commission shall |
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consider data on the cost of services provided to comparable |
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recipients enrolled in the STAR + PLUS Medicaid managed care |
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program to calculate the upper payment limit component of the PACE |
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program reimbursement rates. The cost of those services includes |
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the Medicaid capitation payment per recipient and Medicaid payments |
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made on a fee-for-service basis for services not covered by the |
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capitation payment. |
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Sec. 32.0533. DATA COLLECTION: PACE AND STAR + PLUS |
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MEDICAID MANAGED CARE PROGRAMS. The commission, in collaboration |
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with the Department of Aging and Disability Services, shall modify |
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the methods by which the commission and the department collect data |
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for evaluation of the PACE and STAR + PLUS Medicaid managed care |
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programs to allow comparison of recipient outcomes between the |
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programs. The modification to data collection methods must include |
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changes to: |
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(1) survey instruments that measure recipient |
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experience; |
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(2) compilation of the same or similar complaint, |
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disenrollment, and appeals data; and |
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(3) compilation of the same or similar hospital |
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admissions and readmissions data. |
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Sec. 32.0534. EVALUATION AND REPORT COMPARING PACE AND STAR |
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+ PLUS MEDICAID MANAGED CARE PROGRAMS. (a) The commission, in |
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collaboration with the Department of Aging and Disability Services, |
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shall conduct an evaluation of the PACE program that compares |
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Medicaid costs and client outcomes under the PACE program to |
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Medicaid costs and client outcomes under the STAR + PLUS Medicaid |
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managed care program. The commission must design the evaluation in |
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a manner that: |
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(1) compares similar recipient types between the |
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programs; and |
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(2) accounts for geographic differences and recipient |
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acuity. |
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(b) The evaluation required under this section must include |
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an assessment of future cost implications if the commission fails |
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to establish a reimbursement methodology under the PACE program in |
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accordance with Section 32.0532. |
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(c) The commission shall compile a report on the findings of |
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the evaluation under this section. Not later than December 1, 2016, |
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the commission shall submit the report to the Legislative Budget |
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Board and the governor. |
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(d) This section expires September 1, 2017. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2015. |